The Voice of Podiatrists

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July 05, 2012 #4,506 Publisher-Barry Block, DPM, JD

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FL Podiatrist Discusses Treatment of Bunions

We've all heard that those sky-high heels aren't the best for your foot, and they can be harmful for women with an existing foot malformation such as a bunion. An abnormality of the big toe joint, bunions form when the big toe pushes up against the other toes forcing the joint in the opposite direction. "It's also the deviation and the angle between the first and second toe bones called the metatarsal bones. And that deviation can get worse with time," says Dr. Andrew Belis, a podiatrist and foot and ankle surgeon on Lee Memorial Health System's medical staff.

Dr. Andrew Belis

Doctors have several options for treating bunion pain. "Sometimes just a simple matter of wearing wider shoes or more supportive shoes. If there's some joint pain associated with the problem, then sometimes we can offer them palliative care, possibly an injection or medication to calm it down," says Dr. Belis. Using orthotics, which are molded shoe inserts, may help alleviate the pain and slow the growth process. As far as correcting the problem surgically, "there are different options nowadays, and a lot newer technology that's being offered, and a lot more variety of different surgeries," says Dr. Belis.

Source: Amy Oshier, WNBC [7/3/12]

NY Podiatrist Discusses Onychomycosis

An estimated 35 million Americans have onychomycosis, and you can understand why -- despite having spent more than $350 million in 2010 alone trying to get rid of it -- they don't much like discussing it: Toenails turn embarrassingly yellow and crumbly from fungi that squeeze under them and then hide out. And, oh, yes, for reasons not clearly understood, the fungi dig in even deeper as we age.

Dr. Krista Archer

"Feet are the most neglected body part until there is a problem," says Dr. Krista Archer, a Manhattan foot specialist and podiatric surgeon. While some people are genetically prone to onychomycosis, others -- including swimmers and athletes -- unintentionally leave themselves open to it because of certain behavioral patterns. Maybe they go barefoot in public areas. Or maybe their feet are often damp -- just the environment that fungi thrive in.

Source: Palos Verdes News [7/4/12]

NYCPM Faculty and Students Conduct 8th Annual West Point Boot Fit

Faculty members from the New York College of Podiatric Medicine (NYCPM), along with twenty of the school’s students, on July 3rd and 5th  worked feverishly to fit the more than 1,200 new cadet candidates of the U.S. Military Academy at West Point with properly-fitting boots. The NYCPM volunteers found cadet candidates with a variety of pre-existing problems, ranging from blisters to bunions, hammertoes, and other conditions, and referred them to their company medic. Properly-fitting boots go a long way toward maintaining the cadets’ foot health and, as a result, their overall health and their ability to meet the Academy’s demanding expectations.

NYCPM Faculty and Student Volunteers with Col. Neely (in Army uniform)

Leading the effort were Col. Michael Neary, DPM, MBA, Chief of the Podiatry Service at Keller Army Community Hospital, and Michael J. Trepal, DPM, NYCPM’s Vice President for Academic Affairs and Dean. Other NYCPM faculty members taking part were Russell G. Volpe, DPM,  Susan M. Rice, DPM, and Jose Loor, DPM.

NY and IL Podiatrists Featured at NCVH Annual Meeting

Drs. Marc A. Brenner and Stephanie Wu moderated the wound care sessions at the prestigious New Cardio Vascular Horizons (NCVH) meeting in New Orleans. Dr. Wu's lecture was "Detection and Identification of PAD in Patients with Diabetes." Dr. Brenner's lectures were: "You Bring Me the Blood, I'll do my Job", "Exotic Cutaneous Lesions for Wound Healers", "Keep them Walking after Digital Amputation," and "Interprofessional Relationships Between Podiatric Medicine and Vascular Surgery."

Dr. Marc Brenner and Stephanie Wu

"The meeting was a great success. It was well attended by a diversified group of physicians and healthcare professionals," says Brenner, Co-Chair of the NCVH meeting. "Limb salvage requires a highly dedicated interprofessional team, and this collaboration was the core of the meeting."

Query: Vasospect Supplies

The Vasospect was a neat, rechargeable battery-operated photoplethysmograph that was accurate in the analysis of degrees of venous insufficiency. It is out of production and the company that carried on support (electrode tape, ink refills) is also defunct. Does anyone out there know of supplies for this unit?
 
Robert Teitelbaum, DPM, Naples, FL, mfvandange@aol.com

RE: Newton Running Shoes and Forefoot Pain (Pete Smith, DPM)
From: Dennis Claire, DPM

It's likely the Newtons have contributed to the forefoot and Achilles pain. They promote a midfoot/forefoot running form with internal lugs that help transfer the runner's weight forward. In addition, the Insanity workout videos likely contributed just as much to the forefoot pain and Achilles insertional tendonitis. These 40-minute high intensity exercises put the person on the ball of the foot through much of the workout, which includes lots of jumping, squatting, burpees, planks, jump-roping, and more. All of these exercises are ballistic movements which place significant loads at the Achilles and ball of the foot. 

I'm a supporter of minimalist/barefoot running because I believe it encourages a more efficient way to run, but it can be dangerous to immediately switch into (The same can be said for the Insanity workouts and other high intensity interval training (HIIT) like bootcamp and Crossfit). Forefoot and Achilles injuries seem to be the most common. 

With running, a gradual, guided program to switch to a midfoot strike is essential. I suggest patients perform gastroc-soleus stretches until they can attain 15-20 deg. dorsiflexion (extended knee) before they even begin in minimalist shoes. They also need to cut their miles back significantly or begin with just 1/2 mile or less in minimalist or Newton shoes as well as perform form drills and dynamic stretching. Runners who want to transition must put in the time on form and technique and let go of the weekly mileage/PR/pace/race focus that many have.
 
Dennis Claire, DPM, Bangor, ME, donncha10@yahoo.com

RE: EHR Exemption for Small Practices? (Michael Brody, DPM)
From: Mark H. Sugar, DPM

I am 65 years old and in practice since 1974. After scrutinizing EMR or EHR last year for thousands of dollars, I decided that I would not participate in this program, take my lumps and bumps, and forego the meaningful use incentive payments by the government. I would like to address Dr. Brody's comments and ask what penalties will be enforced in 2016 when I may very well be out of podiatry; and also address the issue of electronic referrals (which at this time make up less than 1% of my referrals in my practice). My feeling is that I can conduct my solo practice until I retire successfully and without EHR. Am I wrong? Are there others who feel as I do?  

Mark H. Sugar, DPM, Hyattsville, MD, msugar8364@aol.com

RE: Nurse Practitioners Modernization Act
From: Robert Bijak, DPM

In the midst of back slapping the success of the NYS scope law increase (for a few DPMs only), the NYS Assembly PASSED the "Nurse Practitioners Modernization Act" (NYSA05308A), whereby after 3 years of working with a physician sponsor, (ALL) nurse practitioners may independently open their own office (with no further exams) and "practice to the full extent as a physician in that specialty." They need no co-signing of any prescriptions. 

It was interesting to note that the opponents referenced podiatry as another NON-physician group trying to increase scope. The dissenting legislators were clear that the line between non-physicians and physicians is being blurred to the detriment of the public in that non-MD/DO school-trained providers did not have the depth of education and training "to call upon their broad knowledge in even the most mundane exam," thereby not giving the patient the quality of care of a real physician.

It's clear to me that our present trajectory is at best keeping up with nurses, and it is imperative that an immediate declaration be made by the APMA and the schools that the DPM program (philosophy of practice) will be a plenary program, as the DOs have made the musculoskeletal system their "raison d'etre" (reason for existence). The medical paradigm is changing, and unless we jump up to the next level. we will continue to be an allied profession like nurses, pharmacists, and physical therapists, all who are also trying to sue their way to increased scope.

Robert Bijak, DPM, Clarence Center, NY rbijak@aol.com

RE: Unrestricted Medical Licenses (Larry Kansky DPM, JD)
From: Elliot Udell, DPM

My apologies to Dr. Kansky and others if my comments made in an earlier posting landed as a broad condemnation of PA's and nurse practitioners. As an allergy sufferer, my practitioner of choice, when feeling ill, is the PA who works for my allergist. Many other patients share these fond sentiments for him.

My response, however, was to Dr. Levy's comment that in this day and age, even though a person with four years of medical school and one year of internship could legally do open heart or brain surgery, no hospital would allow it unless the practitioner had many years of surgical training and passed boards in his or her respective surgical specialty. In this context, the same should apply to PAs and nurse practitioners.

As consumers of medical care, we deserve to get...

Editor's note: Dr. Udell's extended-length letter can be read here.

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